Job Description
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Coding Specialist performs reviews of claim line details to support the Risk Adjustment and HEDIS programs and work with Community's Risk Adjustment and HEDIS vendors. The coding specialist will coordinate with internal and external resources in determining the appropriateness of diagnosis and procedure codes found in administrative and medical claims; review data elements to support the submissions for Risk Adjustment and HEDIS; to review and validate accuracy of HCC'S identified in suspecting and RADV audit medical records; and develop reports of findings and recommendations for the Risk Adjustment and HEDIS team.
QUALIFICATIONS:
- High School diploma or equivalent. Associate's or Bachelor's degree preferred
- Three years'experience in Healthcare coding in the medical industry. Clinical documentation improvement experience required.
- Certified Coder or Medical Billing and Coding certification required.
- Acute care and hospital outpatient coding environment experience and Risk adjustment coding methodology experience preferred.
OTHER SKILLS:
Medical Terminology, Research, MS Word, MS Excel
Medical coding expertise (CPT, ICD9/10 CM/PCS, HCPCS)
Strong written and verbal communications skills.
Solid Knowledge of Medicaid and Commercial coding practices.
Community employees benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.